The Correlation Between Inflammatory Factor Lever And Recurrence Of Atrial Fibrillation After Radiofrequency Ablation In One Week

Background and purpose:Atrial fibrillation（Atrial fibrillation,AF）is one of the most common clinical arrhythmias,and its incidence and prevalence are increasing year by year.The current treatment strategies for AF can be attributed to rhythm control,heart rate control,stroke prevention and comprehensive management.Ablation surgery has been increasingly used as a rhythm control strategy for AF patients,but there is still a certain recurrence rate after AF.Related studies have shown that the early recurrence rates were 15.9%and 45.0%respectively,with the average recurrence rate being 36.9%^[1,2],and the long-term recurrence rate after AF surgery was as high as 20%.%-40%^[3,4].Some studies have shown that about 37%-49%of early relapses have late relapses^[5,6],indicating that there are both connections and differences between early and late relapses of atrial fibrillation,and the pathogenesis of the two is different.Many factors have been confirmed to be associated with long-term recurrence after AF ablation,such as left atrial diameter（LAD）,AF type,age,left atrial volume,etc.At the same time,studies have shown that the mechanism of early recurrence after radiofrequency ablation（RFCA）of AF is related to the arrhythmogenic effect of radiofrequency ablation^[7-12].Relationship and predictive value of recurrence within a week.Methods:A total of 542 consecutive inpatients who underwent radiofrequency ablation for AF in the Department of Cardiovascular Medicine of our hospital from October2021 to April 2023 were selected,including 212 females and 330 males,with an average age of 63.74±10.57 years.All patients were collected their basic information,including age,gender,smoking history,BMI,comorbidities（hypertension,diabetes and coronary heart disease）and so on.Fasting cubital venous blood was drawn before operation to detect uric acid（UA）,preoperative white blood cell count（WBC）,preoperative neutrophil percentage（%NEUT）and other laboratory indicators,and preoperative echocardiography was used to measure left atrial diameter（LAD）,right atrial diameter（RAD）,left ventricular ejection fraction（LVEF）.Blood was drawn within 24 hours after operation to measure various inflammatory factors[interleukin-1β（IL-1β）,interleukin-2（IL-2）,interleukin-4（IL-4）,Interleukin-5（IL-5）,Interleukin-6（IL-6）,Interleukin-8（IL-8）,Interleukin-10（IL-10）,Interleukin-12P70（IL-12P70）,Interleukin-17（IL-17）,Tumor Necrosis Factor-a（TNF-a）,Interferon-a（IFN-a）,Interferon-γ（IFN-γ）]levels,postoperative WBC,and postoperative%NEUT.All patients underwent electrocardiographic monitoring and electrocardiogram（including conventional 12-lead electrocardiogram,dynamic electrocardiogram or long-term dynamic electrocardiogram）to determine whether there was AF recurrence.The patients were divided into recurrence group and non-relapse group according to the recurrence situation at 1 week after operation.Univariate analysis and binary Logistic regression analysis were used to analyze the relationship between related inflammatory factors and other factors and postoperative AF recurrence.Receiver operating characteristics（The predictive value of the ROC）curve evaluation index.Results:1.The recurrence rate within one week after radiofrequency ablation of the selected patients was 17.73%（96 patients with recurrence and 446 patients without recurrence）,including 249 patients with paroxysmal atrial fibrillation（PAF）,persistent AF（persistent atrial fibrillation,Ps AF）293 cases,overall 212 females,330males,mean age 63.74±10.57 years old.2.Univariate analysis of factors affecting recurrence:the levels of IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,TNF-a,and IFN-γamong the 12 cytokines in the recurrence group were significantly higher In the non-relapse group（P<0.05）,IL-6was significantly higher than the normal value,while there was no statistical difference in the levels of IL-1β,IL-12P70,IL17,and IFN-a between the two groups（P>0.05）;There was no significant difference in gender,age,smoking history,hypertension history,diabetes history,coronary heart disease history,BMI index,LAD,LVEF,preoperative and postoperative WBC,and preoperative and postoperative%NEUT between the two groups（P>0.05）,the proportion of persistent AF and the size of RAD in the recurrence group were higher than those in the non-relapse group,and the differences were statistically significant（all P<0.05）.3.Binary Logistic regression analysis showed that postoperative IL-6 and AF type were independent risk factors for AF recurrence within 1 week after operation.The area under the curve（AUC）of IL-6 to predict postoperative AF recurrence in patients was 0.812,the optimal cut-off value was 8.13pg/ml,the sensitivity was0.813,and the specificity was 0.764.The AUC was 0.619,the sensitivity was 0.656,and the specificity was 0.585.Conclusions:1.The recurrence rate within 1 week after AF radiofrequency ablation of the included patients was 17.73%.2.Postoperative IL-6 level and AF type were significantly correlated with AF recurrence within 1 week after radiofrequency ablation,which can be used as independent predictors of recurrence within 1 week after radiofrequency ablation in AF patients.3.When postoperative IL-6≥8.13pg/ml or patients with persistent AF,the probability of AF recurrence within 1 week after radiofrequency ablation increases significantly.The area under the curve（AUC）of IL-6 to predict postoperative AF recurrence in patients was 0.812,the sensitivity was 0.813,and the specificity was0.764.The AUC for AF type was 0.619,the sensitivity was 0.656,and the specificity was 0.585.